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Joseph‐Mathurin N, Feldman RL, Lu R, Shirzadi Z, Toomer C, Saint Clair JR, Ma Y, McKay NS, Strain JF, Kilgore C, Friedrichsen KA, Chen CD, Gordon BA, Chen G, Hornbeck RC, Massoumzadeh P, McCullough AA, Wang Q, Li Y, Wang G, Keefe SJ, Schultz SA, Cruchaga C, Preboske GM, Jack CR, Llibre‐Guerra JJ, Allegri RF, Ances BM, Berman SB, Brooks WS, Cash DM, Day GS, Fox NC, Fulham M, Ghetti B, Johnson KA, Jucker M, Klunk WE, la Fougère C, Levin J, Niimi Y, Oh H, Perrin RJ, Reischl G, Ringman JM, Saykin AJ, Schofield PR, Su Y, Supnet‐Bell C, Vöglein J, Yakushev I, Brickman AM, Morris JC, McDade E, Xiong C, Bateman RJ, Chhatwal JP, Benzinger TLS. Presenilin-1 mutation position influences amyloidosis, small vessel disease, and dementia with disease stage. Alzheimers Dement 2024; 20:2680-2697. [PMID: 38380882 PMCID: PMC11032566 DOI: 10.1002/alz.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Amyloidosis, including cerebral amyloid angiopathy, and markers of small vessel disease (SVD) vary across dominantly inherited Alzheimer's disease (DIAD) presenilin-1 (PSEN1) mutation carriers. We investigated how mutation position relative to codon 200 (pre-/postcodon 200) influences these pathologic features and dementia at different stages. METHODS Individuals from families with known PSEN1 mutations (n = 393) underwent neuroimaging and clinical assessments. We cross-sectionally evaluated regional Pittsburgh compound B-positron emission tomography uptake, magnetic resonance imaging markers of SVD (diffusion tensor imaging-based white matter injury, white matter hyperintensity volumes, and microhemorrhages), and cognition. RESULTS Postcodon 200 carriers had lower amyloid burden in all regions but worse markers of SVD and worse Clinical Dementia Rating® scores compared to precodon 200 carriers as a function of estimated years to symptom onset. Markers of SVD partially mediated the mutation position effects on clinical measures. DISCUSSION We demonstrated the genotypic variability behind spatiotemporal amyloidosis, SVD, and clinical presentation in DIAD, which may inform patient prognosis and clinical trials. HIGHLIGHTS Mutation position influences Aβ burden, SVD, and dementia. PSEN1 pre-200 group had stronger associations between Aβ burden and disease stage. PSEN1 post-200 group had stronger associations between SVD markers and disease stage. PSEN1 post-200 group had worse dementia score than pre-200 in late disease stage. Diffusion tensor imaging-based SVD markers mediated mutation position effects on dementia in the late stage.
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Nair SK, Xie ME, Kalluri A, Ran K, Kilgore C, Halbert-Elliott K, Huang J, Lim M, Bettegowda C, Xu R. The influence of prior percutaneous rhizotomy on outcomes following microvascular decompression for trigeminal neuralgia. J Neurosurg 2024; 140:1155-1159. [PMID: 37862713 DOI: 10.3171/2023.8.jns231345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Microvascular decompression (MVD) is an effective intervention in patients with trigeminal neuralgia (TN). How prior rhizotomy can impact long-term pain outcomes following MVD is not well understood. In this study, the authors sought to compare pain outcomes in patients who had undergone primary MVD versus those who had undergone secondary MVD after a single or multiple rhizotomies. METHODS The authors retrospectively reviewed the data on all patients who had undergone MVD at their institution from 2007 to 2020. Patients were included in the study if they had undergone primary MVD or if their surgical history was notable for past rhizotomy. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and final follow-up appointments. Perioperative complications were noted for each patient, and evidence of pain recurrence was recorded as well. A history of rhizotomy as well as other variables that might influence TN pain recurrence were evaluated using a Cox proportional hazards model. The impact of prior rhizotomy on TN pain recurrence following MVD was further assessed using Kaplan-Meier survival analysis. RESULTS Of 1044 patients reviewed, 947 met the study inclusion criteria. Of these, 796 patients had undergone primary MVD, 84 had a history of a single rhizotomy before MVD, and 67 had a history of ≥ 2 rhizotomies prior to MVD. Patients in the single rhizotomy and multiple rhizotomies cohorts exhibited a greater frequency of preoperative numbness (p < 0.001), higher preoperative BNI pain scores (p < 0.005), and higher rates of postoperative numbness (p = 0.04). However, final follow-up BNI pain scores were not significantly different between the primary MVD and prior rhizotomy groups (p = 0.34). Cox proportional hazards analysis revealed that younger age, multiple sclerosis, and female sex independently predicted an increased risk of pain recurrence following MVD. Neither a history of a single prior rhizotomy nor a history of multiple prior rhizotomies independently increased the risk of pain recurrence. Furthermore, Kaplan-Meier analysis of pain-free survival among the 3 groups revealed no relationship between a history of prior rhizotomy and pain recurrence following MVD (p = 0.57). CONCLUSIONS Percutaneous rhizotomy does not complicate outcomes following subsequent MVD for TN pain. However, patients undergoing rhizotomy before MVD may have an increased risk of postoperative facial numbness compared to that in patients undergoing primary MVD.
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Affiliation(s)
- Sumil K Nair
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Michael E Xie
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Anita Kalluri
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Kathleen Ran
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Collin Kilgore
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Kyra Halbert-Elliott
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Judy Huang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Michael Lim
- 2Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Risheng Xu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Kalluri AL, So RJ, Ran KR, Xie ME, Kilgore C, Nair SK, Huang J, Bettegowda C, Xu R. Preoperative Characteristics and Postoperative Pain Outcomes in Trigeminal Neuralgia With Concomitant Autoimmune Disease. Neurosurgery 2023; 93:1075-1081. [PMID: 37306434 DOI: 10.1227/neu.0000000000002549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/06/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although the association between multiple sclerosis and trigeminal neuralgia (TN) is well established, little is known about TN pain characteristics and postoperative pain outcomes after microvascular decompression (MVD) in patients with TN and other autoimmune diseases. In this study, we aim to describe presenting characteristics and postoperative outcomes in patients with concomitant TN and autoimmune disease who underwent an MVD. METHODS A retrospective review of all patients who underwent an MVD at our institution between 2007 and 2020 was conducted. The presence and type of autoimmune disease were recorded for each patient. Patient demographics, comorbidities, clinical characteristics, postoperative Barrow Neurological Institute (BNI) pain and numbness scores, and recurrence data were compared between groups. RESULTS Of the 885 patients with TN identified, 32 (3.6%) were found to have concomitant autoimmune disease. Type 2 TN was more common in the autoimmune cohort ( P = .01). On multivariate analysis, concomitant autoimmune disease, younger age, and female sex were found to be significantly associated with higher postoperative BNI score ( P = .04, <0.001, and <0.001, respectively). In addition, patients with autoimmune disease were more likely to experience significant pain recurrence ( P = .009) and had shorter time to recurrence on Kaplan-Meier analysis ( P = .047), although this relationship was attenuated on multivariate Cox proportional hazards regression. CONCLUSION Patients with concomitant TN and autoimmune disease were more likely to have Type 2 TN, had worse postoperative BNI pain scores at the final follow-up after MVD, and were more likely to experience recurrent pain than patients with TN alone. These findings may influence postoperative pain management decisions for these patients and support a possible role for neuroinflammation in TN pain.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
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Nair SK, Xie ME, Ran K, Kalluri A, Kilgore C, Halbert-Elliott K, Huang J, Lim M, Bettegowda C, Xu R. A Case Series of Stereotactic Radiosurgery First for Trigeminal Neuralgia: A History of Stereotactic Radiosurgery Does Not Complicate Microvascular Decompression. Oper Neurosurg (Hagerstown) 2023; 25:353-358. [PMID: 37432012 DOI: 10.1227/ons.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The influence of prior stereotactic radiosurgery (SRS) on outcomes of subsequent microvascular decompression (MVD) for patients with trigeminal neuralgia (TN) is not well understood. To directly compare pain outcomes in patients undergoing primary MVD vs those undergoing MVD with a history of 1 prior SRS procedure. METHODS We retrospectively reviewed all patients undergoing MVD at our institution from 2007 to 2020. Patients were included if they underwent primary MVD or had a history of SRS alone before MVD. Barrow Neurological Institute (BNI) pain scores were assigned at preoperative and immediate postoperative time points and at every follow-up appointment. Evidence of pain recurrence was recorded and compared via Kaplan-Meier analysis. Multivariate Cox proportional hazards regression was used to identify factors associated with worse pain outcomes. RESULTS Of patients reviewed, 833 met our inclusion criteria. Thirty-seven patients were in the SRS alone before MVD group, and 796 patients were in the primary MVD group. Both groups demonstrated similar preoperative and immediate postoperative BNI pain scores. There were no significant differences between average BNI at final follow-up between the groups. Multiple sclerosis (hazard ratio (HR) = 1.95), age (HR = 0.99), and female sex (HR = 1.43) independently predicted increased likelihood of pain recurrence on Cox proportional hazards analysis. SRS alone before MVD did not predict increased likelihood of pain recurrence. Furthermore, Kaplan-Meier survival analysis demonstrated no relationship between a history of SRS alone and pain recurrence after MVD ( P = .58). CONCLUSION SRS is an effective intervention for TN that may not worsen outcomes for subsequent MVD in patients with TN.
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Affiliation(s)
- Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Collin Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyra Halbert-Elliott
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Nair SK, Xie ME, Ran K, Kalluri A, Kilgore C, Huang J, Lim M, Bettegowda C, Xu R. Outcomes After Microvascular Decompression for Sole Arterial Versus Venous Compression in Trigeminal Neuralgia. World Neurosurg 2023; 173:e542-e547. [PMID: 36889635 DOI: 10.1016/j.wneu.2023.02.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE In most cases of trigeminal neuralgia (TN), the trigeminal nerve is compressed by the arterial vasculature. We sought to address the gap in understanding of pain outcomes in patients with sole arterial versus sole venous compression. METHODS We retrospectively reviewed all patients undergoing microvascular decompression at our institution, identifying patients with either sole arterial or venous compression. We dichotomized patients into arterial or venous groups and obtained demographics and postoperative complications for each case. Barrow Neurological Index (BNI) pain scores were collected preoperatively, postoperatively, and at final follow-up, as well as recurrence of pain. Differences were calculated via χ2 tests t tests, and Mann-Whitney U Tests. Ordinal regression was used to account for variables known to influence TN pain. Kaplan-Meier analysis was used to determine recurrence-free survival. RESULTS Of 1044 patients, 642 (61.5%) had either sole arterial or venous compression. Of these cases, 472 showed arterial compression and 170 showed sole venous compression. Patients in the venous compression group were significantly younger (P < 0.001). Patients with sole venous compression showed worse preoperative (P = 0.04) and final follow-up (P < 0.001) pain scores. Patients with sole venous compression had significantly higher rate of pain recurrence (P = 0.02) and BNI score at pain recurrence (P = 0.04). On ordinal regression, venous compression was found to independently predict worse BNI pain scores (odds ratio, 1.66; P = 0.003). Kaplan-Meier analysis showed a significant relationship between sole venous compression and increased risk of pain recurrence (P = 0.03). CONCLUSIONS Patients with TN with sole venous compression show worse pain outcomes after microvascular decompression compared with those with only arterial compression.
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Affiliation(s)
- Sumil K Nair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anita Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Collin Kilgore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Strain JF, Cooley S, Kilgore C, Nelson B, Doyle J, Thompson R, Westerhaus E, Petersen KJ, Wisch J, Ances BM. The Structural and Functional Correlates of Frailty in Persons With Human Immunodeficiency Virus. Clin Infect Dis 2022; 75:1740-1746. [PMID: 35404408 PMCID: PMC10200329 DOI: 10.1093/cid/ciac271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons with HIV (PWH) are at increased risk of frailty, a clinically recognizable state of increased vulnerability resulting from aging-associated decline in multiple physiologic systems. Frailty is often defined by the Fried criteria, which includes subjective and objective standards concerning health resiliency. However, these frailty metrics do not incorporate cognitive performance or neuroimaging measures. METHODS We compared structural (diffusion tensor imaging [DTI]) and functional (cerebral blood flow [CBF]) neuroimaging markers in PWH with frailty and cognitive performance. Virologically controlled PWH were dichotomized as either frail (≥3) or nonfrail (<3) using the Fried criteria. Cognitive Z-scores, both domain (executive, psychomotor speed, language, and memory) and global, were derived from a battery of tests. We identified three regions of reduced CBF, based on a voxel-wise comparison of frail PWH compared with nonfrail PWH. These clusters (bilateral frontal and posterior cingulate) were subsequently used as seed regions of interest (ROIs) for DTI probabilistic white matter tractography. RESULTS White matter integrity connecting the ROIs was significantly decreased in frail compared with nonfrail PWH. No differences in cognition were observed between frail and nonfrail PWH. However, reductions in white matter integrity among these ROIs was significantly associated with worse psychomotor speed and executive function across the entire cohort. CONCLUSIONS We conclude that frailty in PWH can lead to structural and functional brain changes, including subtle changes that are not detectable by standard neuropsychological tests. Multimodal neuroimaging in conjunction with frailty assessment could identify pathological brain changes observed in PWH.
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Affiliation(s)
- Jeremy F Strain
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Sarah Cooley
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Collin Kilgore
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Brittany Nelson
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - John Doyle
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Regina Thompson
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | | | - Kalen J Petersen
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Julie Wisch
- Department of Neurology, Washington University, St. Louis, Missouri, USA
| | - Beau M Ances
- Department of Neurology, Washington University, St. Louis, Missouri, USA
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Strain JF, Barthelemy N, Horie K, Gordon BA, Kilgore C, Aschenbrenner A, Cruchaga C, Xiong C, Joseph-Mathurin N, Hassenstab J, Fagan AM, Li Y, Karch CM, Perrin RJ, Berman SB, Chhatwal JP, Graff-Radford NR, Mori H, Levin J, Noble JM, Allegri R, Schofield PR, Marcus DS, Holtzman DM, Morris JC, Benzinger TLS, McDade EM, Bateman RJ, Ances BM. CSF Tau phosphorylation at Thr205 is associated with loss of white matter integrity in autosomal dominant Alzheimer disease. Neurobiol Dis 2022; 168:105714. [PMID: 35358703 PMCID: PMC9701560 DOI: 10.1016/j.nbd.2022.105714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/26/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hyperphosphorylation of tau leads to conformational changes that destabilize microtubules and hinder axonal transport in Alzheimer's disease (AD). However, it remains unknown whether white matter (WM) decline due to AD is associated with specific Tau phosphorylation site(s). METHODS In autosomal dominant AD (ADAD) mutation carriers (MC) and non-carriers (NC) we compared cerebrospinal fluid (CSF) phosphorylation at tau sites (pT217, pT181, pS202, and pT205) and total tau with WM measures, as derived from diffusion tensor imaging (DTI), and cognition. A WM composite metric, derived from a principal component analysis, was used to identify spatial decline seen in ADAD. RESULTS The WM composite explained over 70% of the variance in MC. WM regions that strongly contributed to the spatial topography were located in callosal and cingulate regions. Loss of integrity within the WM composite was strongly associated with AD progression in MC as defined by the estimated years to onset (EYO) and cognitive decline. A linear regression demonstrated that amyloid, gray matter atrophy and phosphorylation at CSF tau site pT205 each uniquely explained a reduction in the WM composite within MC that was independent of vascular changes (white matter hyperintensities), and age. Hyperphosphorylation of CSF tau at other sites and total tau did not significantly predict WM composite loss. CONCLUSIONS We identified a site-specific relationship between CSF phosphorylated tau and WM decline within MC. The presence of both amyloid deposition and Tau phosphorylation at pT205 were associated with WM composite loss. These findings highlight a primary AD-specific mechanism for WM dysfunction that is tightly coupled to symptom manifestation and cognitive decline.
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Affiliation(s)
- Jeremy F Strain
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Nicolas Barthelemy
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Kanta Horie
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Brian A Gordon
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA; Department of Psychological & Brain Sciences, Washington University, St. Louis, MO 63110, USA
| | - Collin Kilgore
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | | | - Carlos Cruchaga
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Chengjie Xiong
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA; Osaka City University School of Medicine Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Nelly Joseph-Mathurin
- Department of Radiology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Jason Hassenstab
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA; Osaka City University School of Medicine Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Anne M Fagan
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Yan Li
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Celeste M Karch
- Department of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Richard J Perrin
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Sarah B Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jasmeer P Chhatwal
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Hiroshi Mori
- Osaka City University School of Medicine Asahimachi, Abenoku, Osaka 545-8585, Japan
| | - Johannes Levin
- German Center for Neurodegenerative Disease (DZNE) Munich, Munich, Germany
| | - James M Noble
- Department of Neurology, Columbia University, New York, NY 100310, USA
| | - Ricardo Allegri
- School of Medicine, Universidad de Buenos Aires, Viamonte 430, C1053 CABA, Argentina
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia; Hope Center for Neurological Disorders, Washington University, St. Louis, MO 63100, USA
| | - Daniel S Marcus
- Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - David M Holtzman
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - John C Morris
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Tammie L S Benzinger
- Department of Radiology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Eric M McDade
- Department of Neurology, Washington University, St. Louis, MO 63110, USA
| | - Randall J Bateman
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA
| | - Beau M Ances
- Department of Neurology, Washington University, St. Louis, MO 63110, USA; Department of Radiology, Washington University, St. Louis, MO 63110, USA; Knight Alzheimer's Disease Research Center, Washington University, St. Louis, MO 63110, USA.
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Cooley SA, Paul RH, Strain JF, Boerwinkle A, Kilgore C, Ances BM. Effects of anticholinergic medication use on brain integrity in persons living with HIV and persons without HIV. AIDS 2021; 35:381-391. [PMID: 33252494 PMCID: PMC7855412 DOI: 10.1097/qad.0000000000002768] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study examined relationships between anticholinergic medication burden and brain integrity in people living with HIV (PLWH) and people without HIV (HIV-). METHODS Neuropsychological performance z-scores (learning, retention, executive function, motor/psychomotor speed, language domains, and global cognition), and neuroimaging measures (brain volumetrics and white matter fractional anisotropy) were analyzed in PLWH (n = 209) and HIV- (n = 95) grouped according to the Anticholinergic Cognitive Burden (ACB) scale (0 = no burden, 1-3 = low burden, >3 = high burden). Neuropsychological performance and neuroimaging outcomes were compared between HIV- and PLWH with high anticholinergic burden. Within a cohort of PLWH (n = 90), longitudinal change in ACB score over ∼2 years was correlated to the rate of change per month of study interval in neuropsychological performance and neuroimaging measures. RESULTS A higher number of anticholinergic medications and ACB was observed in PLWH compared with HIV- (P < 0.05). A higher ACB was associated with worse motor/psychomotor performance, smaller occipital lobe, putamen, subcortical gray matter and total gray matter volumes in HIV-; and poorer executive function, retention and global cognition, smaller brain volumes (frontal, parietal and temporal lobes, hippocampus, amygdala, cortex, subcortical gray matter and total gray matter), and reduced fractional anisotropy (posterior corpus callosum, perforant pathway) in PLWH. PLWH with high anticholinergic burden performed worse on tests of learning and executive function compared with HIV- with high anticholinergic burden. Longitudinally, PLWH who reduced their ACB over time had better neuropsychological performance and neuroimaging measures. CONCLUSION Anticholinergic medications were associated with worse neuropsychological performance and reduced structural brain integrity, and these effects were more widespread in PLWH. Use of anticholinergic medications should be carefully monitored in older adults with deprescription considered whenever possible.
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Affiliation(s)
- Sarah A Cooley
- Department of Neurology, Washington University in Saint Louis
| | - Robert H Paul
- Department of Psychology, University of Missouri, Saint Louis
| | - Jeremy F Strain
- Department of Neurology, Washington University in Saint Louis
| | - Anna Boerwinkle
- Department of Neurology, Washington University in Saint Louis
| | - Collin Kilgore
- Department of Neurology, Washington University in Saint Louis
| | - Beau M Ances
- Department of Neurology, Washington University in Saint Louis
- Department of Radiology
- Hope Center for Neurological Disorders, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Kilgore C. Perspectives. Putting 'systems-based practice' in the med school curriculum. Med Health 2000; 54:suppl 1-4. [PMID: 11184256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Kilgore C, Wagner G, Muller M, Hartless C. You can get there from here. Mater Manag Health Care 1999; 8:28-30. [PMID: 10387511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- C Kilgore
- Inova Fairfax Hospital, Falls Church, VA, USA
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Kilgore C. Perspectives. Expanding coverage signals growing demand, acceptance for alternative care. Med Health 1998; 52:suppl 1-4. [PMID: 10179407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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